Intra-arterial Chemotherapy During Interstitial Hyperthermia for Malignant Glioma : Two Case Reports

Abstract

Purpose Although adriamycin (ADR) exhibits potent anti-tumor effects against malignant glioma cells in vitro, in vivo problems arise because drug delivery to tumor tissues is insufficient, due to the presence of the blood-brain barrier (BBB). However, disruption of the BBB following hyperthermia is well known. We report two cases of malignant glioma treated with intra-arterial chemotherapy during hyperthermia, with concentration of ADR expected to increase following hyperthermia.
Materials and Methods Case 1 involved a 27-year-old female and Case 2 involved a 38-year-old male, both with recurrent right frontal glioma. A cyst in Case 1 and a surgical resection cavity in Case 2 were located adjacent to the tumor, so reservoirs were placed in the cyst and resection cavity. One needle-type electrode was positioned in the tumor utilizing stereotactic procedures in each case.
ADR at 0.5 mg/kg was administrated into the right common carotid artery, and ADR concentration was measured sequentially for baseline values. One week later, the same dose of ADR was injected during hyperthermia, and ADR concentration in the cyst or cavity was sequentially measured by aspiration through the reservoir.
Results ADR concentration gradually increased 15-90 min after intra-arterial administration. Concentration was 4.5-fold higher in Case 1 and 3.6-fold higher in Case 2 following hyperthermia, compared to baseline. Neither case displayed major complications.
Conclusions Maximum concentration of ADR in solution during hyperthermia was higher than during chemotherapy alone.Disruption of the BBB by hyperthermia can be expected to act synergistically with chemotherapy.